California Medical Association Wants Cannabis Legalized & Regulated

The California Medical Association (CMA) has endorsed legalization and regulation of cannabis. At their annual meeting in Anaheim on Oct. 14, CMA delegates supported the conclusions of a position paper, “Cannabis and the Regulatory Void.” The Technical Advisory Committe found that “the public movement toward legalization of medical cannabis has inappropriately placed physicians in the role of gatekeeper for public access to this botanical. Effective regulation is possible only if cannabis is rescheduled at the federal level. Fred Gardner, O’Shaughnessy’s editor, files this report:

Last year the California Medical Association House of Delegates passed a resolution to develop a position statement on marijuana. The committee to draft it was chaired by Don Layman, MD a career state health dept official, and included UCSF oncologist Donald Abrams, MD, George Fouras, MD, a child psychiatrist who is president of the San Francisco Medical Society; David Pating, MD, an Addiction Medicine chief at Kaiser; Larry Bedard, MD, an Emergency Medicine specialist; and Steve Heilig, exec director of the SFMS and editor of their journal, among others. Alice Mead, a former CMA lawyer (who is the U.S. liaison for GW Pharmaceuticals), consulted. Heilig says he was “surprised how easily the CMA board endorsed it and is now running with it. All things in time, i guess.”

Ellen Komp of CaNORML provided the following report:

The California Medical Association (CMA) has endorsed legalization and regulation of cannabis. At their annual meeting in Anaheim on Oct. 14, CMA delegates supported the conclusions of a position paper, “Cannabis and the Regulatory Void.”
TAC found that “the public movement toward legalization of medical cannabis has inappropriately placed physicians in the role of gatekeeper for public access to this botanical. Effective regulation is possible only if cannabis is rescheduled at the federal level.”

The paper’s authors conclude:

Cannabis illegality has perpetuated the effective prohibition of clinical research on the properties of cannabis and has prevented the development of state and national standards governing the cultivation, manufacture, and labeling of cannabis products, similar to those governing food, tobacco and alcohol products, most of which are promulgated by federal agenciesŠ.In order to fully evaluate and regulate cannabis, it should be legalized and decriminalized.

CMA believes that the physician role as “gatekeeper” should be sustained, under Council on Scientific and Clinical Affairs (CSA) guidelines, until such time as the legal and regulatory environment has changed from one in which medicinal cannabis is decriminalized at the state level but illegal at the federal level to a desired environment in which cannabis use is legalized and regulated at both the state and federal levels.

In its background section, the paper states, “Despite extensive law enforcement and other prohibition-related efforts at the state and federal levels, unregulated cannabis continues to be easily accessible, often at low cost. For this and several other reasons further outlined in this white paper, the California Medical Association (CMA) has recognized that the criminalization of cannabis is a failed public health policy.”

TAC outlines its reasons as: the diversion of limited economic resources to the penal system; the social destruction of the families of incarcerated cannabis uses; the disparate impacts on communities of color; a national demand that feeds violent drug cartels from Mexico and elsewhere; and “the failure of the federal government’s limited actions through the ‘War on Drugs’ in mitigating substance abuse and addiction.” It mentions Portugal’s decrim experiment, stating, “In 2006, five years after implementing decriminalization policies, Portugal reportedly had a lifetime cannabis use in people over age fifteen of 10 percent – the lowest in the European Union.”

Cannabis should be “subject to the scrutiny of the federal Food and Drug Administration’s (FDA) regulatory process in order to allow for further clinical research and to work toward standardizing the substance so physicians are no longer required to serve as gatekeepers of a substance that has not been subjected to the scientific process.” In the past ten years, the paper notes, there have been only twelve U.S. clinical trials investigating the therapeutic properties of inhaled cannabis and around twenty clinical studies worldwide. [Thousands of studies have been done on animals, or on cannabinoids in vitro.] The University of California Center for Medicinal Cannabis Research (CMCR), it notes, recently reported to the California legislature upon the results of a number of studies. Among these, four studies involved the treatment of neuropathic pain and all four demonstrated a significant improvement in pain after cannabis administration

With regard to cannabis used recreationally, the paper states, “there is a need for oversight and quality control, just as there is with alcohol, tobacco, and food products. Such oversight and quality control, aimed at protecting personal and public health, can be accomplished with legalization and regulation at both the federal and state levels.”

While acknowledging potential risks of cannabis use to adolescents and others, the paper states, “Epidemiological studies have been inconclusive regarding whether cannabis use causes an increased risk of motor vehicle accidents; in contrast, unanimity exists that alcohol use increases crash riskŠ Cannabis smokers tend to over-estimate their impairment and compensate effectively while driving by utilizing a variety of behavioral strategies.”

Cannabis acquired in California today is unregulated,” the paper states. “Both medical and recreational cannabis have no mandatory labeling standards of concentration (one cannabis clinic labels one lollipop as ‘Three Doses’) or purity (are there harmful pesticides or herbicides present?)”

In order to allow for a robust regulatory scheme to be developed, cannabis must be moved out of its current Schedule I status within the DEA’s official schedule of substances.

Three options exist for rescheduling cannabis and supporting further research:

Move cannabis to an appropriate scientific schedule within the current DEA scheduling structure

Place cannabis on its own schedule with parameters unique from other enumerated schedules

Support the development of local cannabis regulations as an interim alternative pending federal action

Because the DEA has historically denied petitions to reschedule cannabis, CMA should encourage the formation of a national coalition between state medical societies, medical specialty societies, and other relevant groups for the purpose of building support for cannabis rescheduling.

Other recommendations include:

Production & Distribution: Production of cannabis should be held accountable to quality control measures and standardization. All vendors should be licensed and distribution of cannabis should include restrictions on purchase and use to all minors. All cannabis supply should be subject to purity, concentration and product labeling standards. Labeling standards should include warning labels, similar to those on tobacco and alcohol products. Pending federal regulation of cannabis, local regulatory structures should be implemented in order to control the production and supply of cannabis.

Public Safety: Workplace safety should remain a priority, with the enactment of prohibitions against workplace intoxication, similar to the treatment of alcohol use. Also, regulations surrounding driving safety and zero-tolerance for school possession should be implemented.

Tax cannabis: A tax should be levied on cannabis as a means of collecting funds dedicated to regulation, enforcement and education.

Refer for national action: National advocacy is essential to promoting the adoption of consistent, effective regulations at the federal level. Without a national solution, a patchwork of state-by-state decriminalization efforts will persist, thus exposing physicians and members of the public to liability and federal criminal sanctions.

In the past, CMA policy has acknowledged the criminalization of cannabis to be a failed public health policy (HOD 704a-09) and has recognized a public movement toward the legalization of cannabis (HOD 101a-10). As of 2010, CMA supports the rescheduling of cannabis to facilitate further clinical research (HOD 102a-10).

In August 2011, CMS issued recommendations for physicians on medical marijuana, stating it is the opinion of the CMA Council on Scientific and Clinical Affairs that medical cannabis may be effective for treatment of nausea, anorexia, pain and other conditions (i.e., spasticity), but that more clinical research is needed regarding specific indications, dosing, and the management of side effects.

In March 2001, the CMA voted to support the use of medical marijuana in cases of medical necessity, and joined the National Pain Foundation and the California Nurses Association to file an amici curiae brief in United States of America v. Oakland Cannabis Buyers’ Cooperative, et. al.